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PubMed1976

Effects of hypophysectomy and short- and long-term propylthiouracil treatment on the rat thyroid.

The morphology and histology of the post-pharyngeal part of the gastrointestinal tract of the ferret were studied. The oesophagus was a distensible muscular tube. Its mucosa was lined by keratinizing stratified squamous epithelium. The muscle coat was striated throughout except mear the cardia. A cardiac sphincter was present. The stomach was morphologically and histologically very similar to that of man. The duodenum appeared C-shaped and had a mesoduodenum. The bile and pancreatic ducts formed a common duct in the wall of the duodenum. The sphincter of Oddi was present. Brunner's glands were present in the pyloric part of the stomach, and up to the common opening of the bile and pancreatic ducts in the duodenum. The intestine could be differentiated macroscopically and microscopically into small and large intestines. The small intestine distal to the duodenum formed coiled tubes suspended by a mesentery. It was not possible morphologically to differentiate jejunum and ileum. Histologically, however, the distal portion was identifiable as ileum by increasing numbers of goblet cells, and Peyer's patches in the submucosa. Villi were present in the mucosa throughout but there was no spiral or circular fold. The large intestine was a straight dilated tube lying in the left flank and extending from the splenic flexure to the anus in the median plane. It was suspended by a short mesocolon except for the rectal portion in the pelvis. The ileo-colic junction was differentiated morphologically and histologically. There was no caecum, appendix, taeniae coli or appendices epiploicae. The large intestine was not differentiated topographically into ascending, transverse and des

Animals↗
PubMed1979

Surgical treatment of gastroesophageal reflux.

Most investigators agree that the most important goal in correcting gastroesophageal reflux is restoring or developing a competent lower esophageal sphincter. Although the sphincter can be incompetent in its normal intra-abdominal position and rarely a patient may have a competent sphincter in the thorax, generally the sphincter is much more effective in the positive pressure abdominal position. The choice of operative technique will depend upon the abnormal conditions present and the general condition of the patient. The thoracic approach is elected if there is associated intrathoracic disease warranting surgical correction, such as diffuse spasm of the esophagus, achalasia, epiphrenic diverticulum, or a pulmonary lesion requiring biopsy and possible resection. Very obese patients, patients with recurrent hernias, and patients with shortened esophagus are better managed by the thoracic approach. Patients with an essentially normal esophagus are treated with a Mark IV Belsey procedure. If shortening of the esophagus is present, a combination Collis-Nissen technique with fixation below the diaphragm is preferable. The abdominal approach is indicated when there is another intraabdominal disease known or suspected warranting surgical correction. This approach is also useful for the thin or poor risk patient. Usually, through an abdominal incision, we elect to use a modified Nissen fundoplication, with fixation of the fundoplication to the median arcuate ligament or the right crus of the diaphragm. The crural sling is returned to normal dimensions with interrupted sutures. Reflux in the absence of an hiatal hernia initially is treated medically. If symptoms are significant and intractable, a competent lower esophageal sphincter is restored, or developed by the modified Nissen procedure just described. Most reflux strictures at the esophagogastric junction are reversible by dilatation and restoration of a competent sphincter. Firm, fixed, fibrous strictures occasionally cannot be safely dilated. These may be managed by a Thal procedure to correct the stricture and a Nissen fundoplication to prevent recurrent reflux.

Esophageal Stenosis↗
PubMed1975

Neural control of gastric mucosal blood flow in the rat.

This study was designed to determine (1) whether sympathetic nerve stimulation reduces gastric mucosal blood flow through the opening of submucosal arteriovenous anastomoses ("shunts"); and (2) whether parasympathetic nerve stimulation increases gastric mucosal blood flow through a direct effect on vascular smooth muscle as well as through metabolic factors secondary to increased acid secretion. An in vivo microscopy technique for the direct visualization of the rat gastric microcirculation was employed. Stimulation of the splanchnic nerve for 3 min caused an initial constriction of submucosal arterioles followed by escape (dilation during continued splanchnic stimulation) in all rats. No arteriovenous anastomoses were seen either in the resting state or during nerve stimulation. Mucosal studies with splanchnic stimulation revealed an initial progressive slowing of flow in the capillaries, followed by escape (partial return of flow). There were no significant differences between the times to maximum initial circulatory change in the submucosa and mucosa, and between the times to maximum escape in the submucosa and mucosa. These findings indicate that, in the rat, sympathetic stimulation decreases mucosal blood flow through a constricting effect on the supplying submucosal arterioles and not through the opening of "shunts". In studies with vagal stimulation, the submucosal arterioles dilated within 10 sec of beginning stimulation in 45 of 51 observations (P less than 0.001) and decreased in diameter within 10 sec of cessation of stimulation in 45 of 51 observations (P less than 0.001). The immediate dilation with stimulation and constriction with cessation of stimulation suggests a direct vasodilator effect of vagal stimulation on the gastric submucosal arterioles.

Animals↗
PubMed1998

Differential 5-HT3 mediation of human gastrocolonic response and colonic peristaltic reflex.

Colonic motor function is modulated by extended and local neural reflexes involving unknown mediators. To test the role of serotonin (5-HT3) pathways, increases in colonic tone during antral distension and duodenal lipid perfusion (gastrocolonic responses) and changes in orad and caudad colonic tone in response to local colonic distension (peristaltic reflex) were measured after double-blind granisetron (10 microg/kg) or placebo infusion in healthy human volunteers. Antral distension evoked increases in colonic tone, which were blunted by granisetron (P < 0.05) without effects on antral compliance. Intraduodenal lipid perfusion also evoked increased colonic tone, which was reduced by granisetron (P < 0.05). In contrast, orad colonic contractions and caudad relaxations and contractions during colonic distension were unaffected by granisetron. In conclusion, 5-HT3 receptor antagonism blunts both the mechano- and chemoreceptor components of the human gastrocolonic response without altering antral compliance. In contrast, 5-HT3 pathways play no role in the ascending or descending components of the colonic peristaltic reflex. These findings demonstrate different roles for 5-HT3 receptors in the control of colonic motor function by the proximal gastrointestinal tract and by local neural reflexes.

Adult↗
PubMed2005

Post-ERCP pancreatogastric fistula associated with an intraductal papillary-mucinous neoplasm of the pancreas--a case report and literature review.

BACKGROUND: Fistula formation has been reported in intraductal papillary-mucinous neoplasms (IPMNs) with or without invasion of the adjacent organs. The presence or absence of invasion is mostly determined by postoperative histological examination rather than by preoperative work-up. CASE PRESENTATION: A 72 year-old Japanese woman showed remarkable dilatation of the main pancreatic duct (MPD) in the distal region of the pancreas. Subsequent ERCP also showed MPD dilatation, after which the patient suffered moderate pancreatitis. A subsequent gastroscopy revealed a small ulceration that had not been observed in a gastroscopy performed 3 months prior. Mucinous discharge from the ulceration suggested it might be the orifice of a fistula connected to the MPD. En bloc resection including the distal region of the pancreas, spleen, stomach and part of the transverse colon was performed under the pre- and intraoperative diagnosis of an invasive malignant IPMN. However, histopathology revealed the lesion to be of "borderline malignancy" without apparent invasion of the stomach. Light microscopy showed inflammatory cellular infiltrates (mainly neutrophils) around the pancreatogastric fistula, but there was no evidence of neoplastic epithelia lining the fistulous tract. CONCLUSION: This case highlights that a pancreatogastric fistula can develop after acute inflammation of the pancreas in the absence of cancer invasion. Further information regarding IPMN-associated fistulae is necessary to clarify the pathogenesis, diagnosis, appropriate surgical intervention and prognosis for this disorder.

Journal Article↗
PubMedDate not supplied

[Microflora in chagasic megaesophagus].

Chagasic patients with megaesophagus were submitted to an endoscopy of the upper digestive tract and the samples were collected with special instruments under sterilized conditions. One of the four samples collected was from the stase liquid and the other three samples were collected from fragments of the esophageal mucosa at one, three and five centimeters from the esophageal-stomach transition (Z line). The samples were analyzed by the Microbiology and Pathologic labs for the identification of microorganisms. After that, the results were correlated with the degree of mega esophagus according to Ferreira-Santos. We observed that the incidence of pathogenic microorganism is very high in megaesophagus, with no relation with the degree of dilatation making the surgery for the treatment of this affection potentially contaminated. There was no significant difference concerning the positivity of the culture relating to the degree of esophagus dilatation.

Adult↗
PubMed2003

[Late results of portacaval surgical shunt in patients with extrahepatic portal hypertension].

Late outcomes of portocaval shunting (PCS) were analyzed in 135 patients with extrahepatic portal hypertension (EPH). It was established that the methods of choice in such patients should be splenorenal anastomosis, mesentericocaval anastomosis (MCA) "side by side" and H-type with autovenous or synthetic insertions. The best results were detected in a combination of portocaval anastomosis with the suturing pf stomach and esophageal varicose veins, if the diameter of the anastomosed vessel was small and portal pressure was reduced by less than 25% (100 mm of water column). The ineffectiveness of MCA "end in side" by Bogoras and cavamesenterial anastomosis was shown due to low efficiency and severe complications, respectively. These data demonstrate efficacy of endovascular dilatation in PCA stenoses, yet the possibilities of severe complications still exist. The best result of endoscopic PCS estimation 1 year after the surgery suggested complete recovery of patients with EPH in most cases.

Adolescent↗
PubMedDate not supplied

[Possibility of Helicobacter pylori invasion into the lamina propria of the gastric mucosa].

Biopsies of the stomach antrum and fundus from 20 male patients with non-ulcer dyspepsia were studied light- and electron-microscopically. Helicobacter pylori infection was found in 60% of cases. In 2 patients, the bacteria were found not only in the fovea and mucus, but in the tunica propria as well. The bacteria were observed in the dilated intercellular spaces of the epithelium, between epithelium and basal membrane as well as around the glands and capillaries in the form of colonies. In the tunica propria the bacteria were represented mainly by the coccus forms, they had the signs of involution. There were signs of the bacterial influence on immunocompetent cells.

Biopsy↗
PubMed1995

Morbidity, ability to swallow, and survival, after oesophagectomy for cancer of the oesophagus and cardia.

OBJECTIVE: To study survival, morbidity, and ability to swallow, after oesophagectomy for cancer of the oesophagus and cardia. DESIGN: Prospective open study. SETTING: University hospital, Norway. SUBJECTS: 83 patients, 38 with squamous cell carcinoma and 45 with adenocarcinoma of the oesophagus and cardia. INTERVENTIONS: Transhiatal (n = 51) and transthoracic (n = 32) oesophagectomy. Oesophageal replacement was by either stomach (n = 80) or colon (n = 3). Cervical anastomosis was used in all but 2. MAIN OUTCOME MEASURES: Early and late morbidity and mortality, length of stay in intensive care unit and in hospital, and survival analysis. RESULTS: 30 Day and in hospital mortality were 0 and 4% for transhiatal, and 6% and 9% for transthoracic, oesophagectomy. Complications included recurrent nerve palsy (n = 7), anastomotic leaks (n = 5), and chylothorax (n = 4). 17 Patients (22%) needed dilatations for stenosis of the anastomosis, and 71 (85%) of the patients left hospital within four weeks of operation. Survival analysis showed a 5 year survival rate of 33% for patients with adenocarcinoma operated on for cure and a 2 year survival of 28% for patients with squamous cell carcinoma. CONCLUSIONS: Oesophagectomy for cure is worthwhile as some patients are cured and most of the remainder have prolonged relief of their dysphagia. Palliative resections should not be done in patients with distant metastases or invasion of adjacent organs by the tumour because of long stay in hospital, appreciable morbidity, and short life expectancy.

Adenocarcinoma↗
PubMed1989

Esophageal resection for achalasia: indications and results.

Although esophagomyotomy is highly effective as the initial surgical treatment of most patients with achalasia, those with either recurrent symptoms after a previous esophagomyotomy or a megaesophagus do not respond as well to esophagomyotomy. Total thoracic esophagectomy was performed in 26 patients (average age, 49 years) with achalasia. Eighteen had a history of a previous esophagomyotomy, and 18 had a megaesophagus (esophageal diameter of 8 cm or larger). In 24 patients, a transhiatal esophagectomy without thoracotomy was the operative approach; 2 patients required a transthoracic esophagectomy because of intrathoracic adhesions from prior operations. The stomach was used as the esophageal substitute in all patients; it was positioned in the posterior mediastinum, and a cervical anastomosis was performed. Intraoperative blood loss averaged 765 mL. Major postoperative complications included mediastinal bleeding requiring thoracotomy (2), chylothorax (2), and anastomotic leak (1). There were no postoperative deaths. The average postoperative hospital stay was ten days. Follow-up is complete and ranges from 3 to 91 months (average duration, 30 months). All but 1 patient with severe psychiatric disease eat a regular, unrestricted diet without postprandial regurgitation. Early postoperative anastomotic dilation was required in 10 patients. Dumping syndrome has occurred in 5 patients. It is concluded that esophagectomy provides the most reliable treatment of esophageal obstruction, pulmonary complications, and potential late development of carcinoma in the patient with a megaesophagus of achalasia or a failed prior esophagomyotomy and that it is a far better option in these patients than esophagomyotomy, cardioplasty procedures, or limited esophageal resection.

Adolescent↗
PubMed1993

[Percutaneous transhepatic gastrostomy with CT guidance in patients with partial gastrectomy].

Percutaneous transhepatic gastrostomy was performed in two patients, one with partial gastrectomy and Billroth I anastomosis and one with esophageal reconstruction with subtotal stomach, in whom oral feeding was precluded. In both patients, percutaneous gastrostomy with fluoroscopic guidance was impossible since the gastric remnants were small, had a high subcostal position, and were overlain by the transverse colon, lung and left lobe of the liver. The only route available to avoid the overlying bowel and lung was the transhepatic approach. The gastric remnants were punctured with a 22-gauge PTC needle through the left lobe of the liver with CT guidance, and an 8 Fr. Cope-type catheter was fluoroscopically placed in the gastric remnant or the duodenum after tract dilatation over the guide wire. No complications occurred during or after the procedures, and the condition of both patients was greatly improved. Although gastrostomy in patients with partial gastrectomy is thought to be very difficult, percutaneous transhepatic gastrostomy with CT guidance is easy and may be safe since adhesion between the liver and gastric remnant can prevent massive hemorrhage or displacement of the catheters.

Aged↗
PubMed1985

Modification of vasopressin- and angiotensin II- induced changes by calcium antagonists in the peripheral circulation of anaesthetized rabbits.

Investigations into the site of vasodilator and antivasoconstrictor activity of calcium antagonists previously performed in cats were extended to a second species, barbiturate-anaesthetized rabbits, and a second vasoconstrictor agent, vasopressin. The dihydropyridine derivative darodipine (code name PY 108-068; 10, 30 and 100 micrograms kg-1 i.v.) showed systemic haemodynamic effects comparable to those seen in cats at half these doses. Darodipine effected regional vasodilatation (measured with tracer microspheres) in the heart, brain and skeletal muscles as in cats. Only the vessels of the adrenals (dilated in rabbits but not in cats), and the kidneys and skin (constricted in rabbits but not in cats) responded differently to darodipine. Angiotensin II (A II; 0.15 and 1.5 micrograms kg-1 min-1) constricted the same vascular beds in rabbits as in cats, namely the heart, kidneys, small intestine, pancreas, spleen, skin and arterio-venous shunts (inferred from microspheres reaching the lungs), the only exceptions being the vessels of the stomach and liver (constriction only in cats) and the adrenals (constriction only in rabbits). Darodipine (30 and 100 micrograms kg-1) attenuated the A II-induced vasoconstriction in the same vascular beds in rabbits as in cats including the kidneys, which were constricted after administration of the antagonist alone. These results indicate surprisingly small species differences for the vasodilator effects of darodipine as well as the attenuation of the vasoconstrictor effects of A II. Lysine-vasopressin (2 and 50 mu kg-1 min-1) did not increase blood pressure in anaesthetized rabbits but dose-dependently lowered heart rate, cardiac output, total peripheral conductance and myocardial contractile force (measured with a strain gauge). Vasopressin constricted all peripheral vascular beds dose-dependently, except for those of the kidney and liver. The effects of vasopressin persisted in the animals infused with placebo solution. Darodipine (30 and 100 micrograms kg-1), but not verapamil (300 and 1000 micrograms kg-1) reversed the vasopressin-induced cardiac depression and decrease in cardiac output. This probably also explains most of the apparent differences between the effects of the two calcium antagonists on the peripheral circulation. Both calcium antagonists diminished the vasopressin constriction in most vascular beds except those of the spleen, skin and arterio-venous shunts. Most of the effects were dose-related but not strictly competitive, as far as this can be judged based on two doses of agonist and antagonist. 9 As with A II the effects of vasopressin were diminished in vascular beds not normally dilated by calcium antagonists. 10 Calcium antagonists display two typical patterns of activity. The vasodilator pattern consists of dilatation of the vesels of the heart, brain and, to a degree varying with the agents, skeletal muscle. The antivasoconstrictor effects occur in some but not all of the vessels constricted by the constrictor agent, vasoconstriction of the spleen, skin and arterio-venous shunts being resistant to the action of calcium antagonists. The pattern of antivasoconstrictor activity appears to depend on the constrictor compound used, inasmuch as such agents constrict different vascular beds.

Anesthesia↗
PubMed1979

Afferent loop obstruction presenting as obstructive jaundice.

The first case of obstructive jaundice secondary to a chronic afferent loop obstruction has been reported. The cause of the obstructed afferent loop was found to be a carcinoma of the gastric pouch occurring 25 years after surgery for peptic ulcer disease. The failure to develop any evidence of pancreatitis despite marked dilatation of the biliary tree and gall bladder suggests the existence of an independent functioning pancreatic sphincter, perhaps the sphincter of Boyden.

Adenocarcinoma↗
PubMed2007

Regeneration of the esophagus using gastric acellular matrix: an experimental study in a rat model.

Recently, tissue engineering of the autologous esophagus has been thought to provide a promising strategy for esophageal substitution. In this study, gastric acellular matrix (GAM) was used as a scaffold for regeneration of the esophagus in a rat model. Usage of GAM has an advantage that naturally derived extracellular matrix autograft can be prepared less invasively in a clinical setting. Twenty-seven F344 female rats were used as recipients. Patch defects created in the abdominal esophagus were replaced by GAM patch grafts. The rats were sacrificed 1 week to 18 months after implantation. The specimen was examined macroscopically as well as microscopically. 5'-Bromo-2'-deoxyuridine (BrdU) proliferation assay was performed in six rats that were sacrificed 1, 2, and 4 weeks after implantation. Twenty-four rats survived without complications. The graft site did not show esophageal stenosis or dilatation in any rat. Keratinized stratified squamous esophageal mucosa was regenerated in the entire graft 2 weeks after implantation. Regeneration of the muscle layer or lamina muscularis mucosae in the graft site was not observed even 18 months after implantation. Marked incorporation of BrdU was observed only in the mucosal layer but not in the muscle layer. GAM patch graft provided satisfactory mucosal regeneration of the esophagus without stenosis or dilatation, although muscle regeneration was still a future challenge.

Animals↗
PubMed1981

Histamine H1- and H2-receptors in the gastric vasculature of the rabbit.

The histamine receptors in the rabbit blood perfused gastric vasculature were analysed pharmacologically. Histamine elicited a monophasic increase in perfusion pressure which was antagonized by mepyramine and enhanced by metiamide. The maximum observed response was enhanced by metiamide to that produced by a specific H1-receptor agonist. It is concluded that the gastric vasculature responds to histamine with an H1-receptor mediated vasoconstriction and an H2-receptor mediated dilatation. In this preparation the H1-effect predominates in response to injection of histamine.

Animals↗
PubMed1998

Severe ventilatory compromise due to gastric distention during pediatric cardiopulmonary resuscitation.

We describe a child in cardiac arrest with severe ventilatory compromise due to gastric distention. During cardiopulmonary resuscitation (CPR), positive pressure ventilation may lead to gastric insufflation because of decreased pulmonary compliance and decreased lower esophageal sphincter tone. Essentially, gas delivered will follow the path of least resistance, which may be to the stomach. In our patient, gastric distention precluded effective ventilation and gastric decompression relieved ventilatory compromise. The values and pitfalls of clinical evaluation and capnography are presented.

Cardiopulmonary Resuscitation↗
PubMedDate not supplied

Study of the effect of jejuno-ileal distension on the motor activity of the stomach with evidence of "entero-gastric inhibitory reflex".

BACKGROUND/AIMS: In chronic constipation due to delayed colonic transit, stasis of the ileal contents with resulting ileal distension may occur. The current study investigated the effect of ileal and jejunal distension on the gastric motility, aiming at elucidating the possible existence of a relationship and its role in the flow through the gut. METHODOLOGY: The response of the gastric pressure to ileal and jejunal balloon distension in increments of 2 mL of saline was recorded in 12 mongrel dogs. The test was repeated after separate local anesthetization of the ileum, jejunum and stomach. RESULTS: 2- and 4-mL ileal balloon distension produced no significant gastric pressure response, while 6- and up to 10-mL distension effected decrease of the antral and corporeal pressures (p < 0.05, p < 0.05, respectively). Jejunal distension produced a gastric pressure decline (p < 0.05) with 4 and up to 10 mL of saline. The gastric pressure decrease did not show significant changes with the various distending volumes. It was maintained as long as ileal or jejunal distension was continued. Distension of the anesthetized ileum or jejunum caused no gastric pressure changes, nor did ileal or jejunal distension produce pressure changes in the anesthetized stomach. CONCLUSIONS: The gastric pressure decline and presumably hypotonia upon ileal or jejunal distension with big volumes postulate a reflex relationship which we call "entero-gastric inhibitory reflex". The small intestine is suggested to slow down gastric emptying through this reflex. A balance is thus created between chyme delivery from the stomach and chyme processing by the small intestine. Reflex derangement in neurogenic and myogenic diseases may result in gastrointestinal disorders, a point that needs to be investigated.

Animals↗
PubMed2005

Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass for morbid obesity.

BACKGROUND: Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass (LRYGBP) present with dysphagia, nausea, and vomiting. Diagnosis is made by endoscopy and/or radiographic studies. Therapeutic options include endoscopic dilation and surgical revision. METHODS: Of 369 LRYGBP performed, 19 patients developed anastomotic stricture (5.1%). One additional patient was referred from another facility. Pneumatic balloons were used for initial dilation in all patients. Savary-Gilliard bougies were used for some of the subsequent dilations. RESULTS: Flexible endoscopy was diagnostic in all 20 patients allowing dilation in 18 (90%). Two patients did not undergo endoscopic dilation because of anastomotic obstruction and ulcer. The median time to stricture development was 32 days (range: 17-85). Most patients (78%) required more than two dilations. The complication rate was 1.6% (one case of microperforation). At a mean follow-up of 21 months, all patients were symptom-free. CONCLUSIONS: Gastrojejunostomy stricture following LRYGBP is associated with substantial morbidity and patient dissatisfaction. Based on our experience, we propose a clinical grading system and present our strategy for managing gastrojejunal strictures.

Adult↗